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What to expect on your first visit

What will happen on the first appointment?

You understandably will feel some apprehension the first time you meet with the pelvic physical therapist for several reasons: you have no idea what they are going to do, you don't understand how physical therapy can help your problem and you know that you will need to talk about some things that are very personal and/or upsetting to talk about. The therapist will know all of this and will spend a lot of time that first session putting you at ease and explaining to you what is going to happen and how physical therapy can help. Pelvic physical therapists are good listeners and empathetic to what you have been going through. They have heard many similar stories and been asked about all manner of things before, so you should not be worried about telling them any concerns you might have.

The therapist will want to know all the details of your problem, which can take some time, as most people have had quite a journey to even get to a physical therapist. They will want to know what you have tried so far, what surgeries or procedures you have had, what medications you are on and what your general health is like. They will also want to know what makes your pain or leaking worse and how it affects your life. The primary difference with having a problem in your pelvis, compared to having a problem in your shoulder or knee for example, is that it affects some of life's most important functions. So the therapist will ask you about how how often you go to the bathroom, whether it is painful to urinate or have a bowel movement and how and if it has affected your sexual relationships. After all, the aims or goals of treatment are often things like being able to have intercourse again without extreme pain, being able to sit through a movie without having to get up to go to the bathroom, being able to have a pain-free bowel movement or being able to return to hiking or the gym without the fear of leaking or your pain increasing.

Internal exams- the lowdown!

At this point the PT will have a good idea of what your problem might be. She will want to do an evaluation of your posture, back and hips; it is important to make sure that these areas are not contributing to your pelvic pain. The PT will then explain to you how physical therapy can help and why an internal examination is important for assessment and treatment. Because of the location of the pelvic floor muscles, the best way to assess and treat them is to work internally. This can be through the vagina in the female or the rectum in the male.

Do I have to have an internal exam-what if it is too painful or I am on my period?

There are several important points to make here-if you are not comfortable with having an internal exam on your first visit, or at all, there are still some things that the PT can work on and advise you to do that will help your condition improve. Sometimes people need a little longer to establish a rapport with the therapist or even to reduce their general pelvic pain to be able to tolerate an internal examination or treatment. Sometimes women are on their period on the first visit and so the internal exam is put off to the second visit. Usually by the time the history is taken and an explanation is given, most people will understand why an internal examination is important and are keen to do anything, including something that might be painful or potentially embarrassing, to get better. The physical therapist will do everything to reduce any pain or embarrassment that you might have.

I didn't know physical therapists did this!

Most people are totally unaware that physical therapists do any internal work (hence this website), it is in our legal scope of practice and the pelvis is just like any other area of the body; it has a lot of muscles, ligaments and fascia which PT's work on, just as they do in the other parts of the body, the pelvic muscles just happen to be in a more awkward area to get to. Physical therapists are licensed to treat this area of the body, just as they are licensed to treat your neck or back, however the therapist will make every effort to make sure that you are comfortable with an internal examination before proceeding.

How do physical therapy internal exams differ from what a doctor does?

Physical Therapy internal exams are different from the pelvic or gynecological exams performed by your medical health practitioner. We do not use a speculum for one thing and we are not evaluating the reproductive, urinary or intestinal organs or systems. We evaluate the pelvic floor muscles, joints, ligaments, fascia and soft tissue structures. Physical Therapists typically do have a little more time than doctors to do the exam and they will be very sensitive to any pain or other issues you may have. PT's are looking for what areas are painful, how much muscle spasm you have, what strength you have in your pelvic floor, whether you can do a good pelvic floor contraction and also whether you can release it, amongst other things.

What else might happen on the first visit?

It can be hard to get through all the history and the examination within in the time allotted, but the therapist is likely to start giving you advice and education on the first visit about what you can do to help and how physical therapy will help. They might also show you some exercises to do at home.

How often will I have to see the physical therapist?

This is of course highly variable amongst patients and PT's. Typically the visits are between 2-3 times a week although that may decrease over time as you get better.